Marianne Welmers

Abstract Background In family treatment, building and evaluating multiple alliances with family members is complex. Methods We investigated the occurrence and development of discrepancies between alliances of different familymembers, and the therapists’ evaluation of multiple alliances and discrepancies. Participants were 92 parents and 61 youths from 61 families receiving home-based family treatment. Family members, therapists, and observers reported early and mid-treatment alliance. Results We found significant discrepancies, with strongest alliances for mothers, followed by fathers, and then youths. Differences became smaller during treatment. Therapist-reports yielded similar discrepancies as compared to client self-reports and observer-reports. At T1, the correlation between therapist- and client self-reports was moderate and significant for alliances with mothers, but insignificant for alliances with fathers and youths. At T2, these correlations were large for alliances with mothers and fathers, but not for youths. Conclusions Our findings demonstrate that therapists have stronger alliances and are more congruent in their alliance perspective with parents (especially mothers) versus youths. Practitioner Points • Our findings demonstrate that in family treatment, differences in alliances between the therapist and familymembers are the rule rather than the exception. Therapists tend to have stronger alliances with mothers than with fathers, and especially youths. The awareness that building alliances with some family members (most often youths) demands an extra effort might enhance the process of building and balancing multiple alliances in family treatment. • Although a shared perspective on the alliance might improve treatment outcome, our findings indicate that therapists tend to bemore congruent in their perspective on the alliance with parents and lack a shared perspective on the alliance with youths. Therapists could ask family members’ feedback on the alliance to gain a more shared perspective, and pay particular attention to children’s and adolescents’ feedback.